Diabetes – Understanding a Debilitating Disease and Its Complications
Last Updated: 11/26/2017
November 11, 2017
Honors in Epidemiology, Ophthalmology Electives
Albert Einstein College of Medicine
According to the article, both of Furst’s parents died from diabetes-related complications when he was only 16 years old. Several weeks later, Furst himself was diagnosed with diabetes, but he basically ignored his condition, stating: “I went into denial…I didn’t realize the long-term effects.”
Unfortunately, after many years spent battling obesity and diabetes, Furst died on June 16, 2017 from “complications of diabetes.”
What Is Diabetes Mellitus – Diabetes mellitus is a devastating chronic illness that can have horrific and debilitating consequences. This condition, if left untreated, can lead to amputations of multiple limbs, blindness, kidney failure, heart attacks, strokes, hypertension, dental disease, poor wound healing, impotence, loss of sensation in limbs, and many other serious health conditions.
Definition – There are three general types of diabetes. Diabetes mellitus type one, which is also called juvenile diabetes, is usually diagnosed in childhood and accounts for approximately 5% of cases of diabetes. This type of diabetes is usually caused by the body’s inability to produce insulin. Diabetes mellitus type 2 is the most common type of diabetes; it involves an elevation of blood-glucose levels in adults.
This can be due either to the lack of production of the hormone insulin by the pancreas or to the development of a condition called insulin resistance, in which the body’s cells no longer react normally to insulin, thereby preventing insulin from transporting glucose from the blood into the cells. The third type of diabetes is gestational diabetes, which refers to the development of high blood-sugar levels during pregnancy.
Statistics – According to Healthline (healthline.com), 29.1 million people in the United States have been diagnosed with diabetes at a cost of 245 billion dollars per year in health expenses (in 2012), with an estimated 8.1 million more people unaware that they too have the condition. Furthermore, in the United States, approximately 1.4 million new cases of diabetes are diagnosed every year. Worldwide, “[d]iabetes kills 1.5 million people every year” (healthline.com).
Risk Factors – Risk factors for diabetes mellitus include obesity, smoking, (advanced) age, sedentary lifestyle, positive family history, poor diet, elevated cholesterol and triglycerides, and hypertension. Also, African Americans, Native Americans, Asian Americans, Pacific Americans and Hispanic Americans all have an increased risk of developing diabetes.
Warning Signs of Diabetes – Common symptoms of diabetes include severe thirst, frequent urination, dry mouth, intense hunger, blurred vision, poor healing of wounds, dry and itchy skin, and yeast infections.
Complications – One of the major complications of diabetes is damage to what is called the body’s “microcirculation.” This term refers to the circulation of blood in the smallest blood vessels, which are composed of terminal arterioles, capillaries, and venules.
The arterioles (tiny arteries) carry oxygenated blood to the capillaries, where oxygen is then transported to the tissues. The venules (tiny veins) carry deoxygenated blood and C02 from the capillaries to the larger veins.
It is critical for microcirculation to work optimally because its function is critical to the regulation of blood flow, tissue perfusion, normal blood pressure, and normal oxygen delivery and cellular-waste removal.
Studies have shown that early in the course of diabetes, changes begin to occur, namely damaging and thickening the “basement membranes” of microcirculation. This causes alterations in blood-flow properties, alterations in oxygen transport, and changes in homeostasis.
These changes in blood supply, tissue perfusion, and oxygen delivery eventually lead to a progressive loss of nerve-fiber function, causing neuropathy, chronic pain, and numbness.
The damage to microcirculation also causes peripheral vascular disease, which can lead to tissue necrosis, nonhealing ulcers, gangrene, and eventual limb amputation. It is estimated that 2 to 6% of patients with diabetes will develop a diabetic foot ulcer (DFU) that eventually becomes infected. Infected DFUs, in turn, can lead to foot or leg amputation, with 50% of those with amputations dying within 5 years.
Diagnosis – Diabetes can be diagnosed using several common blood tests or urinalysis revealing elevated levels of glucose. A fasting blood sugar over 125 mg/dl (for reference, the normal value is less than 100 mg/dl) may indicate diabetes; a Hgb A1C blood test with a value over 5.7%, which measures average blood-sugar levels over a 3-month period, may also indicate diabetes. Another valuable diagnostic test is the glucose tolerance test used to measure blood-sugar levels 3 hours after oral administration of a sugary syrup.
Traditional Treatments – First-line traditional treatment of diabetes usually involves weight loss, a healthy diet low in carbohydrates and high in fruits and vegetables, and increased exercise for at least 20 minutes 3 times a week.
If diet and exercise are not sufficient to lower blood sugar to normal levels, then medication may be necessary. The first medication usually administered is metformin. Metformin, also known as Glucophage, is an oral medication usually taken twice per day; it works by decreasing the level of sugar produced by the liver and by increasing cells’ sensitivity to insulin. It also lowers the amount of glucose absorbed by the intestines.
Since metformin is metabolized by the liver, if someone has decreased liver function caused by liver disease, this may lead to a buildup of metformin, in turn inducing lactic acidosis, which can cause severe medical conditions and even death.
In the same way, since Metformin is excreted from the body by the kidneys, those with kidney disease and/or lowered kidney function are also at risk of lactic acidosis when taking metformin.
Other types of oral medications are also available to treat diabetes. If these medications fail, daily insulin administration can be given either through injections, inhalation, or an insulin pump.
Traditional treatments of diabetic vascular disease causing impaired circulation include revascularization surgery and angioplasties. Treatment of the tingling, numbness, and sharp pain from diabetic neuropathy include medications such as gabapentin (Neurontin), pregablin (Lyrica), and the antiseizure medicine Tegretol.
Alternative treatments for diabetic neuropathy include Chinese medicine, acupuncture, aromatherapy, massage therapy, reflexology, homeopathy, and biofeedback.
Another treatment that has shown great promise both for the treatment of diabetic neuropathy and diabetic microvascular disease is D’OXYVA. This is a noninvasive, nonopioid transdermal delivery system of medical carbon dioxide (C02) and water vapor that boosts microcirculation, balances the sympathetic and parasympathetic nervous systems, lowers blood pressure, decreases chronic pain, promotes healing of wounds and ulcers, and helps prevent amputations.
D’OXYVA improves blood circulation by means of a transdermal transfer of C02 using a transmission device placed over the thumb for a 5-minute period.
Numerous studies have shown “sustained, remote vasodilation and decreased systolic blood pressure” with the use of D’OXYVA. This is because bathing the tissues in C02 stimulates vasodilation in the periphery of the body, thereby improving circulation, blood flow, and oxygenation levels.
In one particular case, a male patient suffering severe diabetic neuropathy and intractable ulcers and open sores on his legs, along with hypertension and an inability to sleep due to severe pain, was placed on D’OXYVA via his thumb for 5 minutes twice a day for 6 weeks.
By the end of the 6-week period, the patient reported a significant decrease in pain; he reported being able to sleep through the night for the first time in years and reported that most of his leg wounds had healed. In addition, his blood pressure dropped from 188/130 to 135/95 within 30 minutes of each application.
Summary – Diabetes is an insidious chronic condition that devastates both patients and families. Increased awareness and preventive measures, such as controlling diet and increasing regular exercise, can encourage weight loss and hopefully prevent the development or worsening of diabetes and the need for oral medications or treatment with insulin. In addition, new advances in therapy such as D’OXYVA offer a noninvasive, transdermal, low-cost, and very effective alternative to help stop the intractable chronic pain of diabetic neuropathy and to help prevent limb amputations.